Ann Dermatol.  2017 Feb;29(1):39-47. 10.5021/ad.2017.29.1.39.

Intense Pulsed Light Alone and in Combination with Erbium Yttrium-Aluminum-Garnet Laser on Small-to-Medium Sized Congenital Melanocytic Nevi: Single Center Experience Based on Retrospective Chart Review

• Lee MS
• Jun HJ
• Cho SH
• Lee JD
• Kim HS

• KMID: 2368026
• DOI: http://doi.org/10.5021/ad.2017.29.1.39

Abstract

BACKGROUND
Treatment of congenital melanocytic nevi (CMN) with intense pulsed light (IPL) has recently produced promising results.
OBJECTIVE
To evaluate the clinical and histological outcomes of small-to-medium sized CMN treated with IPL alone and in combination with erbium: yttrium-aluminum-garnet (Er: YAG) laser.
METHODS
We performed a retrospective chart review of 26 small-to-medium sized CMN treated as described above. The reduction in visible pigmentation, signs of recurrence and any adverse skin changes were evaluated by two independent clinicians.
RESULTS
Seventeen patients completed treatment and were followed-up. Nine were not able to complete treatment due to work, change in residence, and treatment related stress. Ten patients received IPL alone (mean: 10.5 sessions) and 7 underwent treatment with IPL (mean: 7.7 sessions) and Er: YAG/IPL combination therapy (mean: 4.7 sessions). The initial treatment outcome was cleared in 5 patients and excellent in 12. Fourteen patients (82.4%) showed CMN recurrence one year after treatment completion. The histological results from a patient with an excellent clinical outcome showed remnant nevus cells nests in the deep dermis.
CONCLUSION
IPL treatment alone and in combination with Er: YAG laser are not definitive treatments for CMN and should not be considered as first-line treatment.

Keyword

Erbium YAG laser; Intense pulsed light therapy; Nei; Outcome

MeSH Terms

Dermis
Erbium*
Humans
Intense Pulsed Light Therapy
Lasers, Solid-State
Nevus
Nevus, Pigmented*
Pigmentation
Recurrence
Retrospective Studies*
Skin
Treatment Outcome
Erbium

Figure

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  Fig. 1 Flow chart of patients with congenital melanocytic nevi (CMN) treated with intense pulsed light (IPL) alone and in combination with erbium: yttrium-aluminum-garnet (Er: YAG) laser. FU: follow-up.

• 

  Fig. 2 (A) Photo before treatment. (B) Treatment outcome measured at treatment completion is clear in patient 3.

• 

  Fig. 3 (A) Photo before treatment. (B) The outcome at treatment completion is clear in patient 26, (C) but she later on shows recurrence at follow-up evaluation, which is made 14 months after treatment completion.

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  Fig. 4 Epidermal detachment and profound collagen degeneration in the superficial and mid dermis are the findings of a biopsy specimen from patient 1 taken immediately after intense pulsed light treatment (×50; A: H&E, B: periodic acid-Schiff [PAS]).

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  Fig. 5 (A) Photo before treatment. (B) Patient 10 experiences bullae following intense pulsed light therapy. (C) congenital melanocytic nevi is cleared at the time of treatment completion with mild scarring and erythema. (D) Follow-up 29 months after treatment completion.

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  Fig. 6 (A) Photo before treatment. (B) Patient 15, who receives 23 sessions of intense pulsed light (IPL) and 5 sessions of erbium: yttrium-aluminum-garnet/IPL combination therapy achieves improvement of congenital melanocytic nevi but is not able to complete treatment due to change of residence. (C) Follow-up (FU) photo sent from her mother, 5 months after the last treatment shows significant re-pigmentation. (D) Photo FU after the first staged excision.

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  Fig. 7 (A) The clinical photo (patient 11) and (B, C) histology before the start of treatment (×50; B: H&E, C: periodic acid-Schiff [PAS]). (D) A clinical photo after treatment completion (the focal scarring seen here is due to repeated punch biopsy). (E, F) The follow-up skin biopsy shows remnant nevus cells in the deep dermis (×50; E: H&E, F: PAS).

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